Membership Join/Renew Registration

Membership in MPELRA is open to any person whose preponderant duties are to represent or advocate the interests of a government employer or a nonprofit employer engaged primarily in providing serves to the public.  If retired, enter "Retired" or if unemployed, enter "Inactive" under Job Title, then enter the name of your last employer under Employer.

Individual Membership Fee:	$25.00 (Annual fee per person)
Agency Membership Fee:	$75.00 (Annual fee - permits up to four (4) people from the same employer to enroll as members. Use the application form below for either membership.)

Items in Bold are required.
First Name:
Middle Name:
Last Name:
Gender:	Male   Female
Title:
Email:
Address:
City:
State:	Zip:
Phone:
Fax:
Jurisdiction:	Jurisdiction City/Village County Township School District College/University Corporate/Non-profit Other
Employer:
Human Test:
(What day of the week begins with the letter "F"?)
I would like to register more people for this employer. (Up to 3 More)